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HomeMy WebLinkAbout48851-Z SOfUt Gy Town of Southold 7/15/2023 P.O.Box 1179 o - 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 44307 Date: 7/15/2023 J THIS CERTIFIES that the building, IN GROUND POOL Location of Property: 290 Grigonis Path, Southold SCTM#: 473889 Sec/Block/Lot: 70.-3-9 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 1/17/2023 pursuant to which Building Permit No. 48851 dated 2/2/2023 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: accessory in ground swimming pool fenced to code as applied for. The certificate is issued to Nani,Michael of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 48851 4/17/2023 PLUMBERS CERTIFICATION DATED A ize S afore �SofFot� TOWN OF SOUTHOLD BUILDING DEPARTMENT y. x TOWN CLERK'S OFFICE o' • SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 48851 Date: 2/2/2023 Permission is hereby granted to: Nani, Michael 290 Grigonis Path Southold, NY 11971 To: Install in ground swimming pool at existing single family dwelling as applied for. l At premises located at: 290 Grigonis Path, Southold SCTM #473889 Sec/Block/Lot# 70.-3-9 Pursuant to application dated 1/17/2023 and approved by the Building Inspector. To expire on 8/3/2024. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector pf SO!/ryolo Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 aQ sean.devlin(a-town.southold.ny.us Southold,NY 11971-0959 D�yCDU�'�� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Michael Nani Address: 290 Grigonis Path city:Southold st: NY zip: 11971 Building Permit#: 48851 Section: 70 Block: 3 Lot: 9 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: Bethel Electrical License No: 40557ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Commerical Outdoor 1st Floor Pool X New X Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service,3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transfer Switch UC Lights Dryer Recpt Emergency Strobe Heat Detectors Disconnect Switches 4'LED Exit Fixtures Sump Pump Other Equipment: Intermatic pool Panel 4 Circuit/ 3 Used, Timeclock, Pump 220GFI, Heater, 2 Lights- On J&J Trans 30OW 120GFI, Hayward Salt Generator Notes: Pool Inspector Signature: ate: April 17, 2023 S.Devlin-Cert Electrical Compliance Form so�y°o y��,s � �R� �•nnee�� ��� # * TOWN OF SOUTHOLD BUILDING DEIN. couto, 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: <1� aw.,-A� DATE 17INSPECTOR OE 50GTyo -- -- 1 # # TOWN OF SOUTHOLD BUILDING DEPT. courm a 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [/] FINAL? SULOWCAAULKING FRAMING /STRAPPING [ il/ [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL y REMARKS: A 6*1� v sr QC71 0,Vl DATE 90y INSPECTOR DE SOUK,°!o # TOWN OF SOUTHOLD BUILDING DEPT. cou631-765-1802 INSPECTION [ ] FOUNDATION 1ST [XOUPLBG. [ ] FOUNDATION 2ND [ ON/C ULKING FRAMING /STRAPPING [ [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: dv DATE INSPECTOR FIELD INSPECTION REPORT I DATE COMMENTS X13 FOUNDATION (1ST) �y ------------------------------------ p�\C FOUNDATION (2ND) rn z 0 � O ROUGH FRAMING& y PLUMBING + N r r� INSULATION PER N.Y-. STATE ENERGY CODE !f/�r VX-VA oa � FINAL o ADDITIONAL COMMENTS ' )- L-t v173 caA� �rn op � ro r O z y� y x d b H resrv�A SufFacK o� eo� TOWN OF SOUTHOLD—BUILDING DEPARTMENT 5 y� H Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax(631) 765-9502 https://www.southoldtomma.gov Date Received APPLICATION FOR BUILDING PERMIT G For Office Use Only E C (�-' (� ��J E PERMIT NO. �o Building Inspector: ® Ill!�J� IIr57 II 'v/ JAN 11 1023 Applications and forms must be filled out in their entirety.Incomplete applications will not be accepted. Where the Applicant is not the owner,an GUILDINGDEPT. Owner's Authorization form(Page 2)shall be completed. TOWNCIRSO YI'M Date: 0 OWNERS)OF PROPERTY: Name: - ( - SCTM#1000-.____'—( -- -- - --�---- - - - ---- ----- - - ----- --- -O•---- ---- ------ - Project Address: ` --- --- _- -_ �i.� - - - - - -- --- -?-I-� 7 �- -- ---- - Phone#: �' - � � Email: --- ---- - - -)i- k_-I-zon Mailing Address: ;�9 Q J- P `�4©l ! 9 .__--_-...-.-- �_ .. _.__/_. 7_ CONTACT PERSON: Name: Mailing Address: Phone#` Email: DESIGN PROFESSIONAL INFORMATION: Name: _ • Mailing Address: Phone#: - p Email: — CONTRACTOR INFORMATION: Name _.____--.--------..._-- Mailing Address: #: Phone _ _ Email: 3 __oo _ I --1 � _ _ _- _- _co DESCRIPTION OF PROPOSED CONSTRUCTION ❑New StructureAddition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: 16ther i ti<po Will the lot be re-graded? VYes F-1 No Will excess fill be removed from premises? aes ❑No 1 1 ! PROPERTY INFORMATION Existing use of property: S Ik l- � Intended use of property_ Zone or use district in which premises is situated: Are there any covenantsad restrictions with respect to this property? ❑Yes Ao IF YES, PROVIDE A COPY. Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by Chapter 236 of the Town Code. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings, additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code, housing code and regulations and to admit authorized inspectors on premises and in building(s)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted By(print name): Ick( E chi" Ild'Authorized Agent El Owner Signature of Applicant: Date: STATE OF NEW YORK) SS: COUNTY OF -Die-k( being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the (—nn+n-C--6 (Contractor,Agent,Corporate Officer,etc.) of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his/her knowledge and belief;and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this day of , j)p�6-1 ,20�a— �r", NNta lanae Pan'se Stew of New Yost No.OJPA6415578 Qualified in Suffolk Co'mtY PROPERTY OWNER AUTHORIZATION (Where the applicant is not the owner) Non j residing at 2—% (( do hereby authorize I) F�� to apply on my behalf to the Town of Southold Building Department for approval as described herein. / 2/,2-/,/7'2 Owner's Signature Date a i c HAF4 AZAAv Print Owner's Name 2 s r' oO%%3FF �%�4G4` BUILDING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD pyo y= ;; Town Hall Annex- 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr a—southoldtownny:aov seanda-southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: I I0 L Company Name: I -Elr4itcad Name: _ ,l License No.:- �} rj email: .Q e-C nm [i oemF Address: 3—] t _. Phone No.: JOB SITE INFORMATI N (All Information Required) Name: Non j Address: Z Cross Street: Phone No.: _ I — Bldg.Permit#: S email: I) Tax Map District:. 1000 ___Section;' Block: 3 _- Lot: BRIEF DESCRIPTION OF WORK (Please Print Clearly) r L2rlgUtc�rl� Circle All That Apply: Is job ready for inspection?: YES /(N2 Rough In Final Do you need a Temp Certificate?: YES / 1,�, Issued On Temp Information: (All information required) Service Size 1 Ph 3 Ph Size: A #Meters Old Meter# New Service- Fire Reconnect- Flood Reconnect- Service Reconnected- Underground -Overhead #Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE-WITH APPLICATION Request for Inspection FormAs OUF1r(►tC BUILDING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD o Town Hall Annex- 54375 Main Road - PO Box 1179 o` • Southold, New York 11971-0959 41, O� Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr(a southoldtownny.gov— seanda-southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 7 jI Company Name: Bethel Electrical Contracting, Ltd. Electrician's Name: viateur Pilon License No.: ME-40557 Elec. email: Bethelec@optonline.net Elec. Phone No: 631-750-6555 E✓ I request an email copy of Certificate of Compliance Elec. Address.: 1337-8 Lincoln Avenue Holbrook, NY 11741 JOB SITE INFORMATION (All Information Required) Name: MIMLKL, N NN J Address: -7- r-i Q '.s 'S 0. Cross Street: a4kPe-� Phone No.: is( r Bldg.Permit#: email: Tax Map District: 1000 Section: `10 Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly). Swimming Pool Wiring Square Footage: Circle All That Apply: Is job ready for inspection?: ✓ YES ❑ NO ❑Rough In ❑� Final Do you need a Temp Certificate?: ❑ YES F./—] NO Issued On Temp Information: (All information required) Service Size❑1 PhF—]3 Ph Size: A # Meters Old Meter# ❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: Please call our Office with an inspection date and the Homeowner for inspection access _Thank you! ......-.. PAYMENT DUE WITH APPLICATION �, ri o��SUFF01irr�,oG BUILDING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD yTown,Hall Annex- 54375 Main Road - PO Box 1.179 o yc: Southold, New.York 11971-0959 44o� �ao� , Telephone (631) 765-1802 -FAX,(631) 765-9502 i rogerr -south61dtownny.gov— seandta7�southoldtownny..gov 1 APPLICATION.FOR-ELECTRICAL INSPECTION ELECTRICIAN 'INFORMATION (All Information Required) Date:' �I Company Name: .,Bethel Electrical Contracting, Ltd. Electrician's.Name: 'Viateur Pilon License No.: ME-40557 Elec. email: Bethele'c@optonline.net Elec, Phone No: 631-750-65550 I request an email copy of Ce rtifidatel of Compliance bec..Add ress.: 1337=8,Lincoln Avenue Holbrook, NY:11741 {I JOB SITE INFORMATION (All Information Required) - 9 Name:' .tiI1C}-�� NN I Address: . r-i fin .5 O Cross Street: . . �. 0C Phone No.: E'I rn 2,A (} Bldg,Permit#: email: Tax Map District:' . 100.0 , Section: -��:; Block: -> Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly).` j Swimming Pool Wiring = I :Square footage: Circle All That Apply: . . • . •, Is job ready for inspection?,,. YES❑ NO Rough In Final i Do you need a Temp Certificate?: o �/ NO . .,Issued On YES a Temp Information: (All information required) Service Size 1 Ph 3.Ph Size: A #Meters Old Meter# i �NewService❑Fire.Reconnect OFlood ReconnectOService' Reconnect OUnderground00verhead #Underground Laterals , 1 . 2 H Frame. Pole Work done on Service?' Y N ' Additional Information:Please call our 6fflce w'ith an inspection date and the Homeowner for inspection access -Thank.you! I PAYMENT DUE WITH APPLICATION. ]4J y� i - SURVEY OF LOT 3 , ' MAP OF 2 HARVEST HOMES FSTATES 2tJ�J l r.J 1 - ,• ~_+ �::c'.`•'i', SECTION ONE _ E: .f5i FILE No. 53:57 OLEO JULY �8, 19B9'•- •. SITUATED AT SOU'THOLD TOWN OF SOUTHOLD t- . :�t t SUFFOLK COUNTY, NEW YORK } S.C. TAX No. 1000-70-03-09 I,0'� •O :!• SCALE t A=44' 6�5' N OCTOBER 24, 2001 NA i NOVEMBER 30, 2001 ADO GARAGE TO HOUSE PLAN s a JULY 20, 2002 FOUNDATION LOCATION NOVEMBER 5, 2002 FINAL SURVEY f V :' :O' AREA = 20,404.70 sq. ft. 0.468 ac. 04 0 00. o It- . . A PECONIC ABSTRACT INC. WIWAM J. SMITH III A. ►' MARIJO E. SMITH IL V o, �`. p a �� v�►'A ` . ALL OFFSETS ARE SHOWN TO FOUNDATION. z3 �� r W IN t• b� Al 01 0 z,5fc � I van nE of A �� � �� A• ,� s D 5 N.Y.S. UC. No. 40665 • f, WW ON I ffQlotiNGU1WfON�Of WJK'"YO°"`r" Jose A. ingegno wP�s OF ms st,Rver wP Har t1rMwG `"" "'��"°� Lid St.�rveyor INE LAD SEAAL swL1 IIOr E C(�IrlOE1RD r 10 9E A YND Tt GOrlf. �,�� .�� tJ:7rfMIG1rCNS�pICATID lQ4L71�M{t RLH CS A MICN FGQ.WIOY "911R4EY=v s R~AM..ria ON HIS MWm THE mm Cml/glT,coeaerEx1N.Air No we sunep — SubMvbtons — Site worm — (bruGucthn tqu,t I*THEiNwamwaK s- 1V"=.caRnFlCAtp�+s tN7r 70ta E PHONE (431)727-2090 Fax (631)727-1727 f x? TIRE o�tsuttr of W11Y5I AIID(DR El�ltf5 OF 1�E�R0.iF OFFICES LOGIED AT U44{AtC ADDRESS j ANY. NOT SHOWN AAE NOT GUARANiEM 1390 ROU40M AVENUE _ P.O.Sox 1931 -- _---------- -771 SURVEY OF LOT 3 4MAP OF FBz7qn HARVEST HOMES FSTATES SECTION ONE �{. e. }:hrSL -i'i{V S. 19811 s•;_t; � , �'t � I fILE Ido. 5337 FILED JULY - +;r hlei :3r1S SITUATBD AT ` SOUTHOLD r i - TOWN OF SOUTHOLD •` SUFFOLK COUNTY, NEW YORK r,1 (L SC. TAX No. 1000-70-03-09 SCALE 10=4V OCT1 Aro�5• ; 4. 2001 NOVEMBER 30 2001 KR Z ADD GARAGE TO HOUSE PLAN r t 34 JULY t3 JULY 20, 2002 FOUNDATION LOCAMON NOVEMBER 5, 2002 FINAL SURVEY �e V AREA = 20,404.70 71q. ft. 0.468 Aft- -Asy„� �_ P£CONIC A95TRACT INC. eS ` �'" (� WILLIAM J_ SMITH III Is v' MARIJO E. SMITH -'A' ps �r }`T �, ,N1� ` .•.a ALL OFFSETS ARE SHOWN TO FOUNDATION. L ` Ufa • mm lw Moo" �+ O '�:` m0 5 { �"� ;•r��� ••_� � ��urn (IS a N-Y.S. Um Mo. 49668 �yC tAMMOM 3 AUSMgNQ®1l MOM= SA w !kC'Oal '6EE 1iY YOI�f�9PA1E IN josep6 Aa hgegn® Land Surveyor 1 IS Al®471 4L'�YI1F 10 14B F t�ct�s�Ner.as6nW.war� tan Swrm— Sub&Wom — We FtoRs _ CwmkUcftn toswl tvnaN. Alm DOt 714kBtF PHONE(4831)727-2090 Fox (631)727-1727 711E OF MW OF WAYS CFFXES E0041M AT MAW ADDRESS I J�EA3�lfE1t►S OF .1F ANT NGY SN0(1T91 A#M dfA11A1dFEED 95110 7tOtt30XE AVEStU£ _. P.Q.an 4931 _-- ' YORK workers' CERTIFICATE OF INSURANCE COVERAGE STATE Compensation Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrier 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured SPECHT-TACULAR POOLS INC. 631-696-3900 265 BROOKFIELD AVENUE CENTER MORICHES,NY 11934 1c.Federal Employer Identification Number of Insured Work Location of Insured(Only required if coverage is specifically limited to or Social Security Number certain locations in New York State,i.e.,Wrap-Up Policy) 010648957 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company TOWN OF SOUTHOLD BUILDING DEPARTMENT MAIN STREET-TOWN HALL 3b.Policy Number of Entity Listed in Box"1a" SOUTHAMPTON, NY 11968 DBL152822 SOUTHOLD, NY 11971 3c.Policy effective period 09/26/2022 to 09/25/2023 4. Policy provides the following benefits: © A.Both disability and paid family leave benefits. B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: © A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 9/27/2022 By (Wo. hf (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title Richard White, Chief Executive Officer IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE.Mail it directly to the certificate holder. If Box 4B,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be emailed to PAU@wcb.ny.gov or it can be mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit, PO Box 5200, Binghamton, NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board (only if sox 413,4C or 5B have been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law(Article 9 of the Workers'Compensation Law)with respect to all of their employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (12-21) �Illllliiuiiiiiiuiiiiiiiuiiii(ioiiiuiiiiu)iil�l�l Additional Instructions for Form D13-120.1 By signing this form, the insurance carrier identified in Box 3 on this form is certifying that it is insuring the business referenced in Box 1 a for disability and/or Paid Family Leave benefits under the NYS Disability and Paid Family Leave Benefits Law.The insurance carrier or its licensed agent will send this Certificate of Insurance Coverage(Certificate)to the entity listed as the certificate holder in Box 2. The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is cancelled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in Box 3c, whichever is earlier. This Certificate is issued as a matter of information only and confers no rights upon the certificate holder.This Certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This Certificate may be used as evidence of a NYS disability and/or Paid Family Leave benefits contract of insurance only while the underlying policy is in effect. Please Note: Upon the cancellation of the disability and/or Paid Family Leave benefits policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a'certificate holder,the business must provide that certificate holder with a new Certificate of Insurance Coverage for NYS disability and/ or Paid Family Leave Benefits or other authorized proof that the business is complying with the mandatory coverage requirements of the NYS Disability and Paid Family Leave Benefits Law. NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW §220. Subd. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits and after January first,two thousand and twenty-one,the payment of family leave benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b)The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits and after January first,two thousand eighteen,the payment of family leave benefits for all employees has been secured as provided by this article. D13-120.1 (12-21)Reverse 17-MoNbl I I NI- N Y S I F PO Box 66699,Albany,NY 12206 New York State Insurance Fund I nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A A A A A A 010648957 INNOVATIVE RISK CONCEPTS,INC. 179 SOUTH MAPLE AVENUE RIDGEWOOD NJ 07450 *U ' SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SPECHT-TACULAR POOLS INC TOWN OF SOUTHOLD BUILDING 265 BROOKFIELD AVE DEPARTMENT MAIN ST CENTER MORICHES NY 11934 TOWN HALL,54375 NY 25 SOUTHOLD NY 11971 POLICY NUMBER I CERTIFICATE NUMBER POLICY PERIOD DATE Z 2557 589-5 358804 02/28/2022 TO 02/28/2023 01/20/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2557 589-5, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW,AND,WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK,TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE, VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/ CERTVAL.ASP. THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT DIETER SPECHT SPECHT-TACULAR POOLS INC 1 OF 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND Z 4 DIRECTOR,I SURANCE FUND UNDERWRITING VALIDATION NUMBER: 814710120 IIIEIHI�illIE000'000011000011004517273Mll]l llllIlI Form WC-CERT-NOPRINT Version 3(08/29/2019)[WC Policy-25575895] U-26.3 14 [00000000000100457273][0001-0000255758951[##Z][ISBOB-981[Cert NoP{ERT 1][01-00001] ACORO® DATE(MM/DDIYYYY) AC� CERTIFICATE OF LIABILITY INSURANCE 09i27/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Matthew Ruperto Liberty Risk Management, Inc. HCO,17o Ext: (631)569-5633 AX No: (631)569-5636 2333 Route 112 ADDRESS: matthew@libertyrisk.org Medford, NY 11763 INSURERS AFFORDING COVERAGE NAIC# INSURER A: Hartford Fire Insurance Company 19682 INSURED INSURER B: Merchants Insurance Company 23329 Specht-tacular Pools Inc INSURERC: Chubb 265 Brookfield Avenue INSURER D: Center Moriches, NY 11934-1001 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 00000072-1125133 REVISION NUMBER: 47 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR S POLICY NUMBER MM/DD MM/DDIYYYY A X COMMERCIAL GENERAL LIABILITY Y 12 UUN OZ8606 09/18/2022 09/18/2023 EACH OCCURRENCE $ 1 000 000 CLAIMS MADE F—IOCCUR PREM AGE SES Ea occurTO rence) $ 300,000 MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 1-1JECT FI LOC PRODUCTS-COMP/OP AGG $ 2 000 000 OTHER: $ B AUTOMOBILE LIABILITY CAP1068516 03/27/2022 03/27/2023 EO aoocl tleDtSINGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY(Per accident) $ HIREDNON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE F E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Inland Marine 45470320 09/18/2022 09/18/2023 Any One Occur 507,436 C Inland Marine 45470320 09/18/2022 09/18/2023 Newly Acq Equip 100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Town of Southold is included as additional insured,ATIMA,as required by written contract,subject to policy terms,conditions, and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. Main Street,Town Hall AUTHORIZED REPRESENTATIVE Southold, NY 11971 4)11-1� MJR @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by MJR on 09/27/2022 at 10:54AM FINISHED GRADE z >< 4"CONC. SLAB o ry c LU \/ 4"PIPE \ g x=1 �\ x E3000 0 \� M \ � 3'MIN. 6'0 Z 3'MIN. COLLAR LEACHING SECTION COLLAR C) \/ GROUNDWATERJZ J oo� BACK FILL MATERIAL TO BE \ff\ CLEAN SAND AND GRAVEL LEACHING POOL DISTRIBUTION POOL FLUSH INLET LEACHING BASIN DRAINAGE CALCULATIONS STORAGE REQUIRED 350 GAL.APPROXIMATE STORAGE PROVIDED (1)6'0 x 5'DEEP POOL= 22.34 x 5'=111.7 CF(x 7.48 gallons/CF)=855.5 GAL. OF NEIN`\ CID, R THO�1 Op ... Project: i Labcrew Engineering, P.C. Proposed Drywell For: 5PECHT-TACULAR POOLS I�i C. _ 460 Hawkins Avenue The Nani Residence U Ronkonkoma,NY 11779 290 Qigonis Path 1 265 Brookfield Avenue Telephone: 631 676-4881 Southold,NY 11971 i L ' -� J P ) Center Moriches,New York 11934 •.�—�J - Labcreiv@optonline.net ` C , U 7/1_/22 a C) 88475 ��i APPROVED AS NOTED - B.P.# DATE:_a_ -_____ OCCUPANCY OR FEE�BY: NOTIFY BUILDING DEPARTMENT AT USE IS UNLAWFUL 631-765-1802 8AM TO 4PM FOR THE WITHOUT CERTIFICATE FOLLOWING INSPECTIONS: 1. FOUNDATION-TWO REQUIRED ®� OCCUPANCY FOR POURED CONCRETE 2. ROUGH-FRAMING&PLUMBING 3. INSULATION 4. FINAL-CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR CONAPLY WITH ALL CODES OF DESIGN OR CONSTRUCTON ERRORS NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF SOUTHOLD TOWN ZBA SOUTHOLb TOWN PLANNING:BOARD 111MMEDOAT '._Y" SOUTHOLD TOWN TRUSTEES ENCLOSE POOL Tr' ,ODE N.Y.S.DEC UPON COMPLE-ION BEFORE"WA i ER" RETAIN STORM C AAP ER 23�FF PURSUANT TO EUWMCA.VWECMN REQUIRED OF THE TOWN CODE. NOTES v z 1. NO SOIL SURCHARGE PERMITTED WITHIN 4 FEET OF EXCAVATION AT THE SHALLOW END,OR 6 FEET OF EXCAVATION AT THE DEEP END. B 10" 10" 2. THIS POOL MEETS THE REQUIREMENTS OFAN51/APSP/ICC-5"AMERICAN NATIONAL STANDARD FOR RESIDENTIAL INGROVND SWIMMING 38' POOLS"AND 1996 BOCA CODE-SECTION 421.DIVING EQUIPMENT IS NOTALLOWED. 0 0 3. SWIMMING POOL SHALL BE COMPLETELY AND CONTINUOUSLY SURROUNDED WITH A BARRIER CONSTRUCTED[AW REQUIREMENTS OF 0 SECTION 8326.4.2.1 THROUGH R326.42.6 OF THE NEW YORKSTATE RESIDENTIAL CODE(2020)AND IN CONFORMITY WITH ALL SECTIONS 'v OF THE SOUTHOLD TOWN CODE.DWELLING WALL(5)MAY SERVE AS PART OF THE POOL BARRIERAS PER SECTION R326.4.2.8 AND CONDITION(1)ARE MET.OPERABLE WINDOWS IN THE WALLM USED ASA BARRIER SHALL HAVE A SELF LATCHING DEVICE.ACCESS GATES r SHALL COMPLY WITH SECTION 8326.5.2 OF THE NYS RESIDENTIAL CODE(2020)AND BE SELF CLOSING,SELF LATCHING AND BE SECURELY LOCKED WHEN POOL 15 NOT IN USE OR SUPERVISED.ALL GATES ARE TO OPEN AWAY FROM THE POOL AREA. 0 4, DURING CONSTRUCTION THE CONTRACTOR SHALL ERECTA TEMPORARY BARMERAROUND THE EXCAVATION LAW THE CODE OF THE V y A H2O ° 6 0" ro TOWN OF SOUTHOLD. Q j Z 5. POOL MUST BE EQUIPPED WITH AN APPROVED POOL ALARM CAPABLE OF DETECTING ENTRY INTO THE WATERAND SOUNDING AN ~ v _Z AUDIBLE ALARM UPON DETECTION THAT IS AUDIBLE AT POOLSIDE AND IN51DE THE DWELLING. THEALARMMUSTBEINSTALLED, - MAINTAINED AND USED IN ACCORDANCE WITH THE MANUFACTURERS INSTRUCTIONS. THE ALARM MUSTMEETASTM F2208 = 0 "STANDARD SPECIFICATION FOR POOL ALARMS. THE DEVICE MUST OPERATE INDEPENDENT(NOT ATTACH ED TO OR DEPENPENTON)OF U O :2 PERSONS. Lu m , 0 6. POOL SUCTION FITTINGS(EXCEPT FOR SURFACE SKIMMERS)MUST BE PROVIDED WITH A COVER THAT CONFORMS TO ASME/ANSI d N CJ A112.19.8M ORA MINIMUM 18"x'-3"DRAIN GRATE ORA CHANNEL DRAIN SYSTEM. POOL CIRCULATION SYSTEM MUST BE EQUIPPED WITH CONC.WALLS ATMOSPHERIC VACUUM RELIEF IN THE EVENTTHE GRATE COVERS LOCATED WITHIN THE POOL BECOME MISSING OR BROKEN, SUCH PLAN VACUUM RELIEF SYSTEMS SHALL CONFORM WITH ASME A112.19.17 OR BE A GRAVITY SYSTEM APPROVED BY THE TOWN OF SOUTHOLD. POOL SHALL BE PROVIDED WITH AMINIMUM OF2SUCTION FITTINGS OFTHE ABOVE MENTIONED TYPE. THE SUCTION FITTINGS SHALL BE N.T.S. SEPARATED BYA MINIMUM OF 3'AND MUST BE PIPED SUCH THAT WATER 15 DRAWN THROUGH THEM SIMULTANEOUSLY THROUGH A VACUUM RELIEF-PROTECTED LINE TO THE PUMP(OR PUMPS) VACUUM/PRESSURE CLEANING FITTINGS SHALL BE IN AN ACCE551BLE POSITION,MINIMUM OF6"AND NO GREATER THAN 12'BELOW THE MINIMUM OPERATIONAL WATER LEVEL OR BEAN ATTACHMENTTO 18'VINYLCOVERED THE SKIMMER/SKIMMERS.A REQUIRED POOL ATMOSPHERIC VACUUM RELIEF SYSTEM SHALL BE INSTALLEDAS PER NY5 RESIDENTIAL CODE CONCRETE STEPS 8326.6.3(2020)AND IN ACCORDANCE WITH TOWN CODE. v x a 7. ALL ELECTRICAL WORK SHALL COMPLY WITH THE REQVIREMENTS OF NFPA 70(NEC)PRINCIPALLYARTICLE 680 AND THE NYS N RESIDENTIAL CODE SECTIONS 4201 THROUGH 4206.ALL ELECTRICAL DEVICES MUST BE APPROVED BY UNDERWRITERS LABORATORIES AND u m BE PROTECTED BY AGROUND FAULT CURRENT INTERRUPTER(GFCI)CURRENTCARRYING ELECTRICAL CONDUCTORS EXCEPT FOR TH05E 2'ro 4'SAND BOTTOM PROVIDING POWER TO POOL LIGHTING AND POOL EQUIPMENT SHALL MEET THE SEPARATION REQUIREMENTS OF TABLE E4203.5.ALL N METAL ENCLOSURES,FENCES OR RAILINGS NEAR OR ADJACENT TO THE SWIMMING POOL THAT MAY BECOME ELECTRICALLY CHARGED _ DUE TO CONTACT WITH AN ELECTRICAL CIRCUIT SHALL BE EFFECTIVELY GROUNDED. Ln Q) s SECTION A S. WATER SOURCE FILLING THE POOL SHALL BE EQUIPPED WITH A BACKFLOW PROTECTION DEVICE LAW NYS PLUMBING CODE 608. c_'/ } 9. ALL PIPING 15 DIAGRAMMATIC UNLESS OTHERWISE STATED. p �• O Z N.T.S. O 10. WALKS IF PROVIDED SHALL BE NONSLIP AND SLOPE AWAY FROM POOL EDGE. a Z m-4 WATER LINE TOP OF WALL v Qj U --0 11. A MEANS OF EGRESS FOR DEEP AND SHALLOW ENDS MUST BE PROVIDED IAW AN51/APSP/ICC-5 SECTION 6. v 0 S O ° y 4' 10' 4' O 0 0 12. CONTRACTOR TO PLACE THE POOL LAW TOWN OF SOUTHOLD CODE SETBACKS. a d 13. ALL DRAINAGE FROM THE POOL SHALL BE MAINTAINED ON THE SVB)ECT PROPERTY. I 15. THE DESIGN 15 BASED ON A DRAINAGE SOIL WITH c10%SILT. GROUND WATER SHALL NOT EXIST WITHIN THE EXCAVATION. IF GROUND WATER EX15TS WITHIN 6'-0"FROM GRADE,DEWATERING FACILITIES WILL BE REQUIRED. N 16. ALL GAS AND OIL HEATERS(IF INSTALLED)FOR THE INGROUND SWIMMING POOL SHALL BE NATIONAL APPLIANCE ENERGY SECTION B CONSERVATION ACT(NAECA)COMPLIANT. POOL HEATERS SHALL BE TESTED IAW ANSI L1.56 AND SHALL BE INSTALLED LAW MANUFACTURERS SPECIFICATIONS. OIL FIRED POOL HEATERS SHALL BE TESTED LAW UL726. POOL HEATERS SHALL BE LOCATED OR N.T.S. GUARDED TO PROTECT AGAINSTACCIDENTAL CONTACT OF HOT SURFACES BY PERSONS. POOL HEATERS SHALL BE PROVIDED WITH TEMPERATURE AND PRE55URE-RELIEF VALVES. FOR HEATERS NOT PROVIDED WITH AN INTEGRAL BYPA55 SYSTEM.A BYPA55 LINE SHALL BE INSTALLED FROM INLETTO OUTLET TOAWUST WATER„FLOW THROUGH THE HEATER. POOL HEATERS SHALL BE PROVIDED WITH THE a FOLLOWING ENERGY CONSERVATION MEASURES: °O 0 16.1 AT LEAST ONE THERMOSTAT SHALL BE PROVIDED FOR EACH HEATING SYSTEM. ^T 16.2 ALL POOL HEATERS SHALL BE EQUIPPED WITH AN ON-OFF SWITCH MOUNTED FOR EASY ACCESS TO ALLOW SHUTTING OFF THE C m A CHECKVALVE 2'-2" OPERATION OF THE HEATER WITHOUT ADJUSTING THETHERMOSTATSETTINGANDTOALLOWRESTARTINGWITHOUTRELIGHTINGTHE �i c :co PILOTLIGHT. 15 m m FROM SKIMMER COPING AND WALKWAY 10" W N O f- C a PUMP O 0YOTHERS) 16.3 HEATED SWIMMING POOLS SHALL BE EQUIPPED WITH A POOL COVER(EXEMPTED FROM THIS REQVIREMENTARE OUTDOOR POOLS >}co GRADE DERIVING 20%OF THE ENERGY FOR HEATING FROM RENEWABLE SOURCES AS COMPUTED OVER AN OPERATING SEASON) r ¢ 3 r 0 0 WATER LINE 16.4 TIME CLOCKS SHALL BE INSTALLED 50 THE PUMP CAN BE SET TO RUN DURING OFF-PEAK ELECTRICAL DEMAND PERIODS AND CAN BE SET ° Z co o 9 TO RUN THE MINIMUM TIME NECESSARY TO MAINTAIN THE POOL WATER IN A CLEAN AND SANITARY CONDITION IAW APPLICABLE R. o@) coo SANITARY CODE OF NEW YORK STATE. _ = E c "4 UNDISTURBED EARTH �• - o .Y ° TO D15PO5AV - co - O. 17. THIS DRAWING IS FOP,STRUCTURAL SH ELL ONLY.ALLACCE550RIESANDAPPURTENANCESAREDEFINEDBYOTHER5. W ° ° DRYWEIL 3500 P51 POURED CONC. e - C N J 318'REBAR.2)TYP--------- ° 18. BACKFILL WITH CLEAN EARTH,FREE OF ROOTS AND DEBRIS. DO NOTALLOW THE HEIGHT OF BACKFILL TO EXCEED THE HEIGHT OF THE 3 °F_ DIVERTERJ VINYL LINER WATER IN THE POOL BY MORE THAN 8", OR THE WATER TO EXCEED BACKFILL BY MORE THAN 8" VALVE 0 d L a 2"To4"SAND �� 19. PLACE CONCRETE ONSANDYTOLOAM SOIL. REMOVE ANY CLAY DEP051TANPREPLACE W/COMPACTED CLEAN BACKFILL, N '-O. THERE 15 NO MAIN DRAIN IN THIS POOL.SUCTION FOR POOL WATER CIRCULATION 15 PROVIDED BY THE SKIMMERS ONLY.THIS MEETS FILTER REQUIREMENTS OF THE NYS RESIDENTIALCODE-SECTIONR326.5FOP,ENTRAPMENT PROTECTION. OF N[�,v U 21. THE POOL WAS DESIGNED LAW THE FOLLOWING: �n VERnCAL3/8"KEBAB®3'O.C. 21.1. THE NEW YORK STATE RESIDENTIAL CODE-SECTION R326(2020) (NOTSHOWN) 4 �• TO REfVRNS 21.2. THE NEW YORK STATE ENERGY CONSERVATION CONSTRUCTION CODE-SECTION R403.10(2020) i� 21.3. THENEWYORKSTATE FVELGAS CODE(2020) r W 1 21.4. THE NEW YORK STATE SANITARY CODE. CHECKVALVE = i WALL SECTION 21.5. AN51/APSP/ICC-5 STANDARD FOR RESIDENTIAL IN-GROUND SWIMMING POOLS. c (� D PLUMBING SCHEMATIC 21.6. BOCACODE-SECTION 421. .y' N.T.S. N.T.S. 21.7. CODE OF THE TOWN OF SOUTHOLD. Z = I 22. ALL BACKWASH TO BE SELF-CONTAINED ON-51TE. 0(3 .O CG 0" -S